Urinary System Symptoms Research Articles

Effects of creation of bladder flap during cesarean section on long-term residual urine volume and postoperative urinary retention

Aim: Postpartum urinary retention (PUR) is an important clinical condition that is frequently detected after both vaginal and cesarean delivery. The aim of this study was to evaluate PUR in women who did and did not have bladder flaps created during cesarean section and the effect of Kegel exercises on long-term bladder muscle function in those with high postnatal residual urine volume. Methods: This prospective randomized study was conducted with 100 primiparous pregnant women who were to undergo elective cesarean section between April and December 2019. Patients were divided into two groups: The experimental group (bladder flap group, n=50) and the control group (non-bladder flap group, n=50). The study data were collected with the Maternal Information Form and UDI-6. Kegel exercise results, post-void residual volume and urinary system symptoms were assessed on the 2nd and 5th postoperative day and 6 weeks after birth. Results: There were no significant differences between the groups in terms of socio-demographic characteristics, postoperative 5th day and 6th week residual urine volume, postoperative urinary retention volume, urinary system symptoms (UDI-6 scores) and bladder injury. There were significant differences between the groups in terms of residual urine volume, duration of surgery, and pain values assessed on the second day (P=0.045, P<0.001, P<0.001, respectively). Intra group comparisons demonstrated a decrease in residual urine volume in the participants with high residual urine volume after Kegel exercises, and their postoperative 2nd day and 6th week residual urine volumes and UDI-6 scores were significantly different (P<0.001, P<0.001). Conclusion: The present study determined that bladder flaps created during cesarean section increases postoperative urinary retention. In patients with high residual urine volume, Kegel exercises reduce residual urine volumes and urinary symptoms in the long term.

The Effect of the Presence of Lower Urinary System Symptoms on the Prognosis of COVID-19: Preliminary Results of a Prospective Study

Purpose: To investigate the effectiveness of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS), which occur as a natural result of aging and androgen exposure, in predicting disease prognosis in male patients diagnosed with COVID-19. Methods: The study was planned prospectively. The study included 63 male patients over 40 years of age diagnosed with COVID-19. The patients were diagnosed with COVID-19 based on the results of reverse transcription polymerase chain reaction tests of oropharyngeal and nasopharyngeal swabs obtained as per the World Health Organization guidelines. The presence of LUTS was assessed by the International Prostate Symptom Score (I-PSS), a subjective assessment, and the I-PSS was filled for the patients included in the study. The patients were divided into three groups based on their scores in the I-PSS survey: group 1: mild (0–7), group 2: moderate (8–19), and group 3: severe (20–35). The data of all three groups were statistically analyzed. Results: In the assessment performed between the groups, it was identified that for patients in group 3, the length of hospital stay was longer, intensive care requirement was more frequent, and their mortality rates were numerically higher. In the evaluation made regarding the time to intensive care admittance, this was identified to be the shortest in group 3. Conclusion: As a result of our study, we think that in patients with COVID-19, BPH-related LUTS can guide clinicians in predicting prognosis.

Action mechanism of microRNA-1a-3p in mouse neurogenic bladder

Objective To establish a mouse model of neurogenic bladder and to investigate the changes of fibronectin 1 (FN1) and the action mechanism of microRNA (miRNA, miR)-1a-3p. Methods Mice were divided into model group and control group. The model group received subcutaneous injection of myelin oligodendrocyte glycoprotein and mycobacterium tuberculosis, and intraperitoneal injection of pertussis toxin at 48 h. The control group received subcutaneous injection of normal saline. The frequency of urination and the amount of urine output were observed. The mice were sacrificed and the bladder tissue was taken. Three bladders were selected from the model group and the control group for high-throughput sequencing. The changes of FN1 and miR-1a-3p in mouse bladder tissues were detected by real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) and Western blotting. Results The sequencing results were analyzed. As the urinary system symptoms worsened, FN1 increased (4.569±0.426, t=-5.142, P<0.01), while miR-1a-3p decreased (1.623±0.312, t=-3.945, P<0.05). Compared with the control group, the expression of FN1 mRNA [2.501 (1.301, 4.251), F=99.183, P<0.01] and protein [2.937 (1.174, 4.262), F=63.834, P<0.01] in the bladder tissue of the model group was up-regulated, and that of miR-1a-3p was down-regulated [2.401 (1.250, 3.001), F=35.951, P<0.01]. The dual luciferase gene report indicated that FN1 was a direct target gene of miR-1a-3p (0.514±0.027, t=13.355, P<0.01). Conclusion The animal model of neurogenic bladder has urinary frequency, urgency, urinary retention and other symptoms, and the expression of FN1 is up-regulated, while the expression of miR-1a-3p is down-regulated. Therefore, miR-1a-3p may participate in neurogenic bladder formation through regulation of FN1. Key words: Neurogenic bladder; Fibronectin 1; MicroRNA-1a-3p

Benign Prostat Hiperplazisi Tedavisinin Değerlendirmesinde Prostat Kapsüler Arter Rezistif İndeks Değerinin Etkinliği

We aimed to evaluate whether the prostatic capsular artery resistive index can be a parametric criterion in evaluating the efficacy of α-blocker treatment and the severity of the disease in patients with benign prostatic hyperplasia. The clinical and diagnostic investigation findings and the radiographic images were recorded during the treatment and during the application of procedures in the patients who presented to our hospital with lower urinary system symptoms. Then, these data and the information of the respective patients recorded in the hospital database were examined retrospectively. A total of 66 patients were included in the study. Of the patients, 36 with higher IPSS were recommended to be treated and had a mean resistive index of 0.68±0.09, and the patients with lower IPSS had a mean resistive index of 0.65±0.05. The difference between these two values was found to be statistically significant (p&amp;lt;0.05). In 36 patients who were treated for lower urinary system symptoms, the mean resistive index before the treatment was 0.68±0.09. After the treatment, the mean resistive index decreased to 0.64±0.07. This decrease was statistically significant (p&amp;lt;0.05). The mean IPSS was 20.38±4.03 before the treatment and it decreased to 14.38±3.69 after the treatment, showing a statistically significant difference, similarly (p&amp;lt;0.05). We are of the opinion that the resistive index of the posterior capsular artery of the prostate gland is a parametric indicator to determine the severity of the benign prostatic hyperplasia and to assess the efficacy of the treatment with alpha-blocker medications.

The Influence of Intimate Partner Violence on Pregnancy Symptoms.

The current literature contains few studies conducted on the effects of intimate partner violence (IPV) on pregnancy symptoms. Does being subjected to IPV during pregnancy increase the incidence of pregnancy-related symptoms? The aim of the present study was to explore the impact of IPV on pregnancy-related symptoms. The study was conducted as comparative, descriptive, and cross-sectional research with a total of 370 participants. Data were collected using the Domestic Violence Against Women Screening Form, the Pregnancy Symptoms Inventory (PSI), and a descriptive questionnaire. The types of IPV the women in the study had experienced during pregnancy were, in order of frequency, verbal abuse (31.1 %; n = 115), economic abuse (25.9 %; n = 96), physical violence (8.4 %; n = 31), and sexual abuse (5.9%; n = 22). The PSI scores for the pregnant women subjected to physical violence related to gastrointestinal system symptoms (p < .05), cardiovascular system symptoms (p < .05), mental health symptoms (p = 0), neurological system symptoms (p < .05), urinary system symptoms (p < .01), and tiredness or fatigue (p = 0); their total PSI scores (p = 0) were significantly higher statistically than those of women who did not experience physical violence during pregnancy. The scores of the pregnant women subjected to sexual abuse related to mental health symptoms (p < .05), and their total PSI scores (p < .05) were significantly higher than those of women who did not experience sexual abuse. The scores of the pregnant women subjected to economic abuse related to tiredness or fatigue (p < .01) and their mental health symptom scores (p < .05) were significantly higher than those of women who did not experience economic abuse. Our results showed that women subjected to IPV during pregnancy experienced a higher incidence of pregnancy symptoms.

Vitamin D Deficiency and Lower Urinary Tract Symptoms in Women

ObjectiveThe association of vitamin D deficiency and pelvic floor dysfunction has been examined by numerous studies. Lower urinary tract symptoms (LUTS) associated with bladder filling and voiding functions are common in both sexes. A recent study reports a higher incidence of LTUS in men over 50 years old with vitamin D deficiency. The aim of the study is to investigate whether there is a difference in the Lower Urinary Tract Symptoms frequency between women with vitamin D deficiency and the control group or not. Study designIn this case control study, a total of 150 women who had a measured vitamin D level within a month were divided into two groups, one with a serum vitamin D deficiency and the other with a normal vitamin D level. Both groups were evaluated in terms of menopausal status, numbers of pregnancy and delivery, pelvic examination findings, pelvic floor muscle strength, level of pelvic organ prolapse, LUTS scores, and the findings were recorded. Both groups were compared for the presence of lower urinary system symptoms. The BFLUTS validated for Turkish-speaking populations was used to assess lower urinary system symptoms. Statistical analyses were performed via IBM SPSS Statistics 23.0. The results were considered significant at p < 0.05 and a confidence interval of 95%. ResultsVitamin D deficiency was detected in 67.3% of the participants. No significant differences were found between the groups regarding variables that could affect lower urinary system symptoms such as menopausal status, presence of pelvic organ prolapse and neonatal weight (fetal macrosomia) The Pelvic Floor Muscle Strength was significantly lower in the group with vitamin D deficiency than the control group. BFLUTS scores of premenopausal women with vitamin D deficiency were found to be similar to the control group, likewise no significant differences in the BFLUTS scores were detected in postmenopausal women. ConclusionAlthough vitamin D deficiency causes a significant reduction in pelvic floor muscle strength, no significant correlation was found between lower urinary tract symptoms and vitamin D deficiency. There is a necessity of prospective randomized controlled trials to investigate the relationship between vitamin D deficiency and pelvic floor functions.

Comparison of safety and efficacy of silodosin, solifenacin, tadalafil and their combinations in the treatment of double-J stent- related lower urinary system symptoms: A prospective randomized trial.

To evaluate the efficacy and safety of silodosin, solifenacin, tadalafil and their combinations in reducing double J (DJ) stent-related symptoms (SRS). A total of 335 patients who underwent DJ stenting and develop SRS at 1st week were randomized into eight groups. Ureteral stent symptom questionnaire (USSQ) and Quality of life (QOL) scores were noted in each group: Group A-Silodosin (8 mg OD)+ Solifenacin (10 mg OD)+ Tadalafil (5 mg OD), B - Silodosin 8 mg OD, C - Solifenacin 10 mg OD, D- Tadalafil 5 mg OD, E- Silodosin (8 mg OD) + Solifenacin (10 mg OD), F- Silodosin (8 mg 0D)+ Tadalafil (5 mg OD), G- Solifenacin (10 mg OD)+ Tadalafil (5 mg OD) and H-placebo. Analgesic (diclofenac 50 mg) was given as per requirement. All groups received the drugs for 14 days and again USSQ, QOL score with analgesic requirement were noted in each group. USSQ score was similar in all groups at 1st week but all groups (Groups A-G) led to significant decrease in USSQ score at 3rd week as compared to Group H with less requirement of analgesic. However when we compared groups with each other we found that mean USSQ score and analgesic requirement was favoring Group E as compared to other groups. Quality of life score was also best in Group E (mean 1.5) (p<0.05). Combination therapy with silodosin and solifenacin (group E) was effective for relieving SRS with improved quality of life and less requirement of analgesic than any other groups and should be considered in patients who develop SRS.

Adenomyosis and urinary system symptoms

ObjectiveThis study aims to investigate the presence and incidence of overactive bladder (OAB) syndrome in patients diagnosed with adenomyosis and to evaluate the impacts of urinary symptoms on the quality of life of the patients. Materials and methodsA total of 108 individuals including 50 patients with adenomyosis and 58 controls who were admitted to the Obstetrics and Gynecology Department of Bursa, Cekirge State Hospital and Derince Training and Research Hospital between April 2015 and December 2015 were included. The Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to evaluate symptoms. ResultsIrritative urinary symptoms such as nocturia and frequency were seen more frequently in the adenomyosis group (p = 0.001 and p = 0.035). Overactive bladder symptoms were more common in the adenomyosis group (p = 0.0001). ConclusionOur study showed that symptoms of urinary tract symptoms are common in patients with adenomyosis, which adversely affect the quality of life.

Prevalence of idiopathic hypercalciuria in children with urinary system related symptoms attending a pediatric hospital in Bandar Abbas in 2014

BackgroundIdiopathic hypercalciuria is a group of diseases which can be manifested with urinary symptoms. Its importance is due to high prevalence, recurrent infections, and stone formations which are often asymptomatic.ObjectiveThe objective of this study was to determine the prevalence of idiopathic hypercalciuria in children with urinary system related symptoms in Bandar Abbas in 2014.MethodsThis descriptive cross-sectional study was done in 2014 in a children’s hospital in Bandar Abbas (southern Iran) on 321 children who were between 2 months to 14 years old. Random morning urine sample was obtained from all the patients, and calcium to creatinine ratio was assessed for all the patients for two times. Hypercalciuria is defined as urinary calcium excretion rate that is greater than 4 mg/kg per 24 hours in a child older than two years of age. Data was analyzed using IBM SPSS statistics 23.0 software and Chi-square and independent-samples t-test.ResultsAmong the 321 children assessed, 153 (47.7%) had idiopathic hypercalciuria. The mean age of the children with idiopathic hypercalciuria was 55.20±43.71. Prevalence of idiopathic hypercalciuria was 48.3% in children with urinary tract infection, 54.9% and 53.6% in children with microscopic and macroscopic hematuria respectively, In children with dysuria, there were 52.1%, and 51.8% in children with frequency, 49.1% in children with kidney stone which was confirmed with sonography, 28.6% and 37.5% in children with nocturnal and daily urinary incontinency respectively. Results of this study showed no significant relationship between urinary system symptoms and idiopathic hypercalciuria (p>0.05).ConclusionHypercalciuria can be presented with different symptoms associated with urinary symptoms. Therefore, it is recommended to check the urinary calcium level in children with urinary symptoms with no definite etiology.

The effectiveness of transcutaneous electrical neural stimulation therapy in patients with urinary incontinence resistant to initial medical treatment or biofeedback

While there are many options for children with treatment refractory urinary incontinence, there is no single accepted method. This study's aim was to prospectively evaluate the effect of transcutaneous electrical nerve stimulation in children with urinary incontinence resistant to standard medical, urological therapy and/or biofeedback. This study was performed at a university hospital. For inclusion, patients >5 years of age first underwent evaluation with urinary ultrasonography, uroflow-electromyogram and voiding diaries. Treatment with biofeedback, alpha adrenergic blockers, anticholinergics and/or urotherapy was commenced according to uroflow-EMG and voiding diary findings. Patients with partial or no response to this standard therapy were then included in this study, performed between April 2012 and February 2014. Patients with anatomical or neurological causes for urinary incontinence were excluded. TENS was performed on S3 dermatome, every day for 3 months. Each session lasted 20 min with a frequency of 10 Hz and generated pulse of 350 μs. Intensity was determined by the child's sensitivity threshold. Medical treatment and urological therapy was continued during TENS. Uroflow parameters (voiding volume as percentage of expected bladder capacity, Qmax, Qave, flow and voiding time, postvoiding residual urine) and urinary system symptoms (presence of urinary tract infection, frequency, urge incontinence, fractionated voiding and constipation) were compared immediately before commencement and immediately after the completion of 3 months of TENS. Twenty-seven patients were included in this study (4 males, 23 females). Patients' average age was 7.2 years, 11 had overactive bladder and 16 had dysfunctional voiding. Comparison of urinary system symptoms and uroflow parameters before and after TENS are shown in Table. After 3 months of TENS; a statistically significant decrease was observed in the number of patients with frequency, urge incontinence, urinary tract infections and constipation. There was a decrease in the number of patients with fractionated voiding, although this change was not statistically significant. Similarly, for uroflow-EMG parameters; bladder capacity, Qmax, Qave and flow time increased while voiding time and PVR decreased. Changes seen in bladder capacity, Qmax and PVR were statically significant, while other changes were not. Patients' response rates after 3 months of TENS were; complete response in 70.4%, partial response in 22.2% and no response in 7.4%. This study has shown that transcutaneous electrical nerve stimulation is a promising treatment option for standard-treatment refractory children with urinary incontinence.

Atropine Intoxication in a Child after Accidental Ingestion of 200mg Atropine Sulfate - A Case Report

Atropine Intoxication in a Child after Accidental Ingestion of 200 mg Atropine Sulfate - A Case Report Atropine systemic toxicity may causes the anticholinergic toxidrome including pupillary, mucous membranes, skin, urinary, gastrointestinal, cardiac, and central nervous system symptoms. A 6-year-old boy admitted to the emergency department with agitation, vomiting, and fever with a suspect ingestion of atropine sulfate solution. The patient was hospitalized, intubated, sedated with midazolam and mechanically ventilated. Gastric lavage was performed. After treatment with active charcoal, neostigmine and afterwards physostigmine were administered. Atropine sulfate was detected in the blood sample by using high-performance liquid chromatography-diod array detector method. Patient had supportive care until his symptoms resolved. At the end of the fourth day, patient was discharged in a healthy state except bilateral mydriasis which may continue for a week..

The Effect of Untethering on Urologic Symptoms and Urodynamic Parameters in Children With Primary Tethered Cord Syndrome

To evaluate urinary system symptoms (USSs) and urodynamic parameters (UPs) before and after untethering in children with primary tethered cord syndrome (pTCS). USSs and UPs of patients undergoing untethering for pTCS during the period January 2008-July 2012 were evaluated preoperatively and at the postoperative third and 12th months. For analysis, patients were separated into 4 groups according to the presence of USSs: group 1, USSs preoperative positive and postoperative negative; group 2, USSs preoperative positive and postoperative positive; group 3, USSs preoperative negative and postoperative positive; group 4, USSs preoperative negative and postoperative negative. Preoperative and postoperative USSs and UPs were compared. Forty patients (average age, 7.2 years, follow-up of 2.8 years) were included. There were 13 patients in group 1, 11 in group 2, 3 in group 3, and 13 in group 4. All patients showed improvement when preoperative and postoperative USSs and UPs were compared. There was no correlation between USSs and UPs, both preoperatively and postoperatively. USSs and UPs at the postoperative third and 12th months were similar. Patients with no USS showed the most significant improvement in UP after untethering. Our study has demonstrated that untethering in patients with pTCS improves urologic symptoms and UPs. However, there is no correlation between improvement in symptoms and urodynamic findings. Urodynamic changes are similar at the postoperative third and 12th months. As the most significant improvement was seen in patients without USSs, it is important that these patients undergo urodynamic studies preoperatively and postoperatively.

Evaluation of the clinical indications, adverse drug reactions, and finasteride use in patients with benign prostatic hyperplasia in Poland

BackgroundBenign prostatic hyperplasia (LUTS/BPH) is one of the most common urinary disorders in elderly men. The symptoms of the disease include prostate gland enlargement, bladder outlet obstruction, and lower urinary tract symptoms (LUTSs). BPH predisposes patients to bladder infections and bladder stone formation and increases their risk of urinary retention, which in turn causes renal failure. Hence, the disease requires surgical treatment. However, over the recent years, the number of surgical interventions performed in pharmacotherapy has significantly reduced because of the increased efficacy of conservative therapy, including combination treatment mostly with 2 groups of drugs, namely, alpha-1-adrenolitics and other 5-alpha-reductase blockers, with a different pharmacological activity [5].The aim of this study was to evaluate the clinical indications, adverse drug reactions, and finasteride use in patients with diagnosed BPH in Poland. Materials and methodsWe conducted a clinical trial from November 2009 to November 2010 that included 5751 patients who were enrolled in 46 urological centres in Poland. The researchers who conducted the clinical trial were urologists from different regions of Poland. The clinical trial involved 6 follow-up visits. The mean age of the patients was 67 years (range, 45–93 years; median, 67.00; SD, 8.507). The inclusion criteria were as follows: LUTSs, finasteride therapy for at least 2 weeks, age>40 years, and BPH. ResultsPatients self-reported data on LUTSs, the symptom frequency, concurrent diseases, and intensification of urinary system symptoms. In addition, additional examinations were performed, including prostate-specific antigen test, urinary tract ultrasonography with evaluation of residual urine and prostate, and uroflowmetry. The study did not exclude data on the combined treatment with finasteride and alpha-1-adrenolitics. ConclusionFinasteride was demonstrated to be effective, as evidenced by the significant decrease in TPV by 40% even after 12 months. It was also found to contribute to the attenuation of LUTSs, improvement in maximum flow rate, decrease in nocturia, and improvement in QoL.

Percutaneous Removal of a Very Unusual Foreign Body from the Bladder: Case Report and Literature Review

A 45-year-old male patient presented with a complaint of obstructive lower urinary system symptoms, haematuria, suprapubic pain and urethral discharge that had worsened in the last two days. There was a hard nodular swelling at the urethral region of the proximal penile shaft on palpation. An x-ray of the kidneys, ureter and bladder (KUB) demonstrated radiopaque multiple opacities inside the bladder. Cystoscopy was performed and multiple beads connected each other were observed in the urethra and bladder. Cystoscopic removal of the foreign body was impossible because of too many beads knotted in the bladder; thus, a percutaneous surgery was planned. Suprapubic percutaneous cystostomy is an easy and good option for removing objects from the bladder with minimal possible damage to the urethra. (JAEM 2013; 12: 231-3)

E79 The role of medical therapy in the treatment of lower urinary system symptoms following ureteroscopic lithotripsy

E79 The role of medical therapy in the treatment of lower urinary system symptoms following ureteroscopic lithotripsy

Sarcomatoid Carcinoma of the Prostate

Sarcomatoid carcinoma of the prostate is among the rarest malignant neoplasm types and has been well known for its aggressive clinical course. Patient was admitted with the symptoms of lower urinary tract. Transurethral resection of prostate (TUR-P) was carried out. Revealing Gleason 5 + 3 = 8 prostate adenocarcinoma in TUR-P material. Thereby, a Radical Prostatectomy procedure was planned. In operation, frozen examination revealed adenocarcinoma metastasis to the obturator lymph node. The operation was terminated. In the postoperative 3rd month, the patient was re-admitted with acute urinary system symptoms. A cystoscopy performed and complete resection of the mass was performed. The pathological examination reported that the tumor was compatible with undifferentiated adenocarcinoma owing to presence of poorly differentiated tumoral cells and detection of adenocarcinoma in a relatively small (<1%) focus. 4 month after the operation, the patient underwent another cyctoscopic examination which revealed the prostatic lounge and most of the bladder lumen to be filled with tumoral tissue. The tumoral tissues was resected incompletely. This material was diagnosed to be “Sarcomatoid Malignant Tumor” upon the new evidences of progressive dedifferentiation and predominant sarcomatoid appearance, compared with the former TUR-P materials. Subsequent PET-CT scan depicted multiple metastasis. The patient was referred to oncology department. In conclusion, sarcomatoid carcinoma is a malignant variant that brings along diagnostic and treatment difficulties.

Finasterid in der Behandlung der benignen Prostatahyperplasie

Benign prostatic hyperplasia (BPH) is one of the most common urinary disorders in elderly men. The symptoms of this disease are increased prostate size, bladder outlet obstruction and lower urinary tract disorders. It influences bladder infections, bladder stone formation and increases the risk of urinary retention which can cause renal failure. It is necessary for the disease to be treated operatively. The number of conducted surgical interventions for pharmacotherapy has been significantly reduced in recent years due to increased efficacy in conservative therapy including combined treatment mostly with two groups of drugs: finasteride and alpha-blockers with different pharmacological activities. The aim of the study was to evaluate finasteride efficacy in the treatment of benign prostatic hyperplasia. The clinical trial was conducted from October 2008 to November 2009. According to the urologist's recommendation the patients took finasteride at a dose of 5 mg daily. A total of 4,315 patients participated in the clinical trial and were enrolled in 50 urological centres in Poland. The average age of the patients was 66.5 years, the youngest patient was 46 and the oldest was 91 (median 67.00 years, standard deviation SD±8.101). The use of finasteride at least for 2 weeks was the criterion for the patient to be included in the study. The medical trial lasted 12 months and consisted of 6 visits at which data relating to IPSS, QoL, intensification of urinary system symptoms, the results of the additional studies, PSA serum concentrations, the urinary tract USG with evaluation of residual urine and prostate, urine analysis with evaluation of crystalline, uroflowmetry, transrectal ultrasonography (TRUS) and biopsy were recorded. The study did not exclude the combined treatment with finasteride and alpha-adrenergic blocking drugs. Prostatocystitis was diagnosed in 30 men among the patients treated at the first visit after the digital rectal examination (DRE) trial and they qualified for antibiotic therapy. Suspicion of a tumor was diagnosed in 69 (1.59 %) patients of the study group at the first visit after the DRE trial and they qualified for biopsy of the prostate after the PSA trial and TRUS at the second visit. Therefore, 4,216 patients took part in the clinical trial. In the course of 12 months 392 patients were excuded from the study for different reasons: cardiac infarct, apoplexy, resignation without reason and change of address. According to the IPSS scale (International Prostate Symptom Score) a small intensification of symptoms was diagnosed in 676 patients (16%), in 2,830 patients (67%) moderate and in 718 patients (17 %) considerable. Prostate cancer was confirmed histopathologically in 50 (1.15%) out of 69 patients who qualified for biopsy of the prostate. In 2,677 (70%) patients taking both alpha-blocker and finasteride, the progression of disease reduced, the micturation improved considerably and the mass of adenoma of the prostate diminished by 40%. However, in 956 (25%) patients taking only finasteride or finasteride + phytotherapy the mass of adenoma of the prostate diminished by 40%, too. When the medical trial was finished, 212 patients (5.02 %) of the study group who showed intensive symptoms of BPH and the finasteride and alfa-blocker treatment proved not to be effective enough qualified for surgical therapy. A total of 3,824 out of 4,216 (90.7%) patients finished the medical trial and 3,612 (85.6 %) were willing to continue the further therapy.

Does antibiotherapy prevent unnecessary prostate biopsies in patients with high PSA values?

IntroductionWe investigated if antibiotherapy has any role on total prostate specific antigen (tPSA), free prostate specific antigen (fPSA) and fPSA/tPSA ratio in patients with tPSA higher than 2.5ng/ml. We also analyzed if it has any relation with prostate cancer diagnosis rate. Material and methodsA total of 108 patients older than 50 years of age with lower urinary system symptoms and tPSA>2.5ng/ml were included in this study. Antibiotherapy was given to all the cases for three weeks. After that, transrectal ultrasound-guided prostate biopsies were taken from all the patients. Before and after antibiotherapy, “The International Prostate Symptom Score” (IPSS) and “National Institutes of Health Chronic Prostatitis Symptom Index” (NIH-CPSI) questionnaires are performed and serum tPSA, fPSA and fPSA/tPSA values are obtained. ResultstPSA, fPSA and fPSA/tPSA ratio alterations prior to and after antibiotherapy did not show any statistically significant difference (p>0.05). When prostate adenocarcinoma was excluded, a statistically significant decrease was found in IPSS and NIH-CPSI scores for all cases. ConclusionsAntibiotherapy given to patients with prostate specific antigen (PSA) levels higher than threshold value has not led to significant change in prostate needle biopsy decision. Prostate biopsy should be considered without trying antibiotherapy in patients with high PSA values if a suspicion of prostatitis does not exist.

Quality of life in multiple sclerosis patients with urinary disorders: reliability and validity of the Turkish version of King’s Health Questionnaire

MS patients frequently present with urinary system symptoms, which have a negative effect on the quality life. The aim of our study was to demonstrate the validity and reliability of the Turkish King's Health Questionnaire (KHQ) in MS patients. The study included 37 patients. For analysis of test-retest reliability, the Turkish version of the KHQ developed and the "translation-back translation" method was performed. To assess the validity of these results, Multiple Sclerosis Quality of Life Scale (MQoL-54) and Expanded Disability Status Scale (EDSS) were used. The internal consistency (intra-class correlation coefficient: 0.59-0.94) and test-retest reliability (Cronbach's α-score 0.59-0.94) of KHQ were found to be high (p < 0.05). A significant correlation was detected between most of the KHQ subscores and the physical and mental MQoL-54 and EDSS (total and bowel/bladder, p < 0.05) subscores. The KHQ may be used to determine the effect of incontinence on the quality of life for MS patients.

The effectiveness of sildenafil citrate in patients with erectile dysfunction and lower urinary system symptoms and the significance of asymptomatic inflammatory prostatitis

We evaluated the effectiveness of sildenafil citrate on lower urinary system symptoms (LUTS) by using symptom score scales. We also evaluated whether or not the presence of asymptomatic inflammatory prostatitis had an effect on the alteration in the symptom scores. A total of 36 male patients were included in the study. For all the cases, 'International Prostate Symptom Score' (IPSS), 'National Health Institute Chronic Prostatitis Symptom Index' (NIH-CPSI) and 'International Index of Erectile Function' (IIEF-5) were investigated and the scores were calculated in the first visit. Sildenafil citrate was given for 30 days and at the second visit IPSS, NIH-CPSI and IIEF-5 scores were once more analyzed. Afterwards, the alterations of the scores between visits were statistically compared. Mean age of the 36 cases included in the study was 59.03±1.35. When the alterations in parameters of first visit and second visit were evaluated, we found a statistically significant increase in IIEF-5 and a statistically significant decrease in IPSS, IPSS-QOL (Quality of Life). In addition, when the cases were divided into two groups with and without asymptomatic inflammatory prostatitis, in the cases with asymptomatic inflammatory prostatitis, sildenafil citrate caused improvement only in ED, but had no effect on LUTS. Sildenafil citrate use in cases with LUTS and ED has an improving effect on LUTS as well as ED. However, in cases with asymptomatic inflammatory prostatitis, sildenafil citrate did not lead to an improvement in LUTS.